FODMAP 101, Paleo, and Chronic Lyme

What is Low-FODMAP, or better yet, what in the world are FODMAPs?  If these two questions summarize your feelings toward the seemingly foreign acronym, then this post is for you. 

FODMAP Definition   

Overall, "FODMAP," is an acronym used to summarize the varying types of fermentable carbohydrates found in food.  More specifically, "F" stands for "fermentable, " "O" for "oligosaccharides," "D" for "disaccharides, "M" for "monosaccharides," and "P" for polyols, all of which are short and medium chain carbohydrates that contain high amounts of fructose molecules.  That being said, all carbohydrates contain carbon, hydrogen, and oxygen atoms, with the formula defining what type it is.   The simplest form of sugars are made up of 3-7 carbons in their chain, with multiple hydroxyl groups (1 hydrogen & oxygen bonded together & branched off of a carbon), and are known as monosaccharides.  These compounds are called "simple," due to being the most basic form of sugars in food, and thus serve as the building blocks more complex carbohydrate structures. Common monosaccharides include glucose, fructose, and galactose, of which can be found in various natural and chemically engineered sugars including honey and corn syrup. Next, there are disaccharides, which are simply two monosaccharide sugar molecules linked together, with the most common dietary sources being lactose (i.e. milk and other, dairy derived products), maltose (usually derived from wheat), and sucrose (i.e. table sugar). 

Example of a monosaccharide on the left, and disaccharide on the left, which is 2 monosaccharides linked together by an oxygen. 

 Larger carbohydrate chains that are made up of 3-10 simple sugars (i.e. monosaccharides), are known as oligosaccharides, and are abundant in various foods including asparagus, onion, artichoke, legumes, wheat, and garlic.  Last but not least, there are polyols, which are sugar alcohols, or common sugar-free substitutes, including xylitol and sorbitol, while they are also found in real food sources such as grapes, mushrooms, avocado, apricots, and many others.  

Why it Matters 

Overall, the main takeaway from these differing types of carbohydrates found in food, is that the bodies small intestine has a hard time digesting them.  In fact, this is even true for those that are completely healthy. Therefore, when the food that enters the small intestine is unable to be broken down, it remains so when it enters into the large intestine, where it then feeds gut bacteria.  Though having happy gut bacteria is important to obtaining a balanced GI tract, over-feeding them causes the microbes to become over-active, fermenting everything that they can get their "hands" on.  In turn, this causes one to have a variety of symptoms that can range from minor discomfort in one's abdomen, to inhumane, debilitating pain throughout one's entire body. Not only does undigested food in the small intestine cause overgrowth (i.e. SIBO), but it also hinders the large intestine from its key job (water absorption), which is why bloating, bowel issues (constipation and, or, diarrhea), gas, cramps, indigestion, and belching, are all common symptoms of FODMAP intolerance as well.    Enterocyte cells, as mentioned in my previous, leaky gut post here, are one of the major factors in the health status of one's gut, and are also responsible for digesting many FODMAPs. Therefore, if they become damaged or dysfunctional, not only does allergies and other inflammatory health conditions come as a result, but also the chance of FODMAP intolerance and overgrowth. Common triggers of GI damage include gluten, medications (antibiotics, NSAIDs, birth control, etc...), alcohol, legumes, and other items prominent in the SAD (standard American diet), all of which lead to a a leaky gut, which, as mentioned above,  subsequently adds to the likely hood of one becoming noticeably FODMAP intolerant.  FODMAP intolerance can also occur when the expression of Glucose Transport Protein 5 present in the GI tract, becomes dysfunctional, due to it being one of the main fructose transporters in the body.  This cant occur through ingestion of polyols and sugar alochols, due to their direct effect on the function of GLUT5.  As Dr. Sarah Ballantyne mentions in her post, what type of FODMAP one adversely reacts to, can sometimes be brought back to what insufficiency is occuring in the body, with fructose and polyols being related to GLUT5 deficiency, and fructan containing foods, being from a lack of certain digestive enzymes. 

How to Heal 

If intolerance to FODMAPs is caused by a damaged gut, then it is quite obvious that one of the only ways to fully reverse this is to first begin to heal one's gut.  For starters, it is important to eliminate, or at least decrease (depending on the extent of one's intolerance), the amount of dietary sources of fermentable carbohydrates in one's dietary intake, as well as other foods, medications, and substances that have a negative impact on gut health.  This can take anywhere from a few weeks, to months, or even years, depending on the degree of one's health condition. It is also key to get one's gut flora balanced, of which can be done through supplemental probiotics, or probiotic foods.  However, one must be careful while introducing more bacteria to the gut when experiencing FODMAP intolerance, as it may make their symptoms progressively worse.  Truly, it depends on the person, and what is the underlying cause of their gut imbalance.  Below is a brief list of foods high in FODMAPs, however, if you are looking for more information on both gut healing and the information discussed today, I encourage you to purchase Dr. Sarah Ballantyne's, "The Paleo Approach," or visit the various resources provided at the end of this post.  

Experiences With Low-FODMAP   

Dietary changes were the first in my battle with Chronic Lyme Disease.  Therefore, I tend to forget that acronyms such as "FODMAP," are relatively foreign to those in the outside world.  My journey with a low-FODMAP approach to eating came about after I received surgery to release my celiac artery, which was being compressed by my diaphragm that had fallen and cut off all blood flow to my stomach and surrounding digestive organs.  Of course, a long with this major complication, other effects of the untreated Lyme were finally rearing their ugly heads, including small nerve damage throughout my body.  In turn, this caused my small intestine to be paralyzed, which, as you can imagine caused a plethora of other issues inside both my GI tract, and overall body. That being said, before I got surgery, I could barley east, as not only would it fill my entire body with a queer, haunting pain unmatchable to anything I can liken it too, but my face would drain to a deathly grey color, as my body tried to do all it could to the digest food and absorb the nutrients that I was eating.  Once we finally figured out what was wrong in my body through MRA imaging, liquids, typically in the form of smoothies, became my calorie source.  At the time, I wasn't really aware of drinking bone broth to heal my gut, nor did I have a juicer to juice, and to be honest, I was half dead, with no brain power to even think straight.  Eventually, I was able to get surgery, after which I was told that I would be able to eat without any issues.  Of course, this was very exciting, yet much to my disappointment, when I woke up in the recovery room, the nurse told me they had also patched up a gaping hiatal hernia in my esophagus, of which explained much of the severe acid reflux I experienced as a child.  Though I was happy with the surgery, and very thankful indeed, I was left unable to eat solids for another 2-3 months, as my throat healed.  Even scrambled eggs felt like I was trying to swallow marbles, which caused me to choke on most solids, thus leaving me to rely on liquid calories, and mashed foods such as sweet potato and squash, for the majority of my meals once again.  Yet it wasn't only my throat that was a wreck, but also my stomach.  Naturally, I thought that the severe bloating was simply from having no blood flow to my stomach, however, as the months passed and nothing got better, I started to realize that something else must be going on.  Fast forward 6 months, and the "air" that they said was in my stomach due to surgery, didn't leave, nor the pain that came with having a 10 inch surgical drain in my side, once it was pulled out.  In fact, though I was eating 90% Paleo,  my GI symptoms progressively got worse the more I ate.  Not only that, but my skin color began to change for the worse again, and as I would sit outside sleeping on our lawn chairs, I begin to notice bugs would drop dead if they came near me.  It may sound really silly, and an over-exaggeration to some, but it is not, and even family friends thought I looked very toxic.  After countless hours of research, I knew for a fact that I had  SIBO, and while how I treated/still am dealing with this overgrowth is an entire story all together, it was putting these pieces of the puzzle together, that ultimately brought me to eating "low-FODMAP." Soon, I will be delving deeper into how I sought out healing from SIBO, but in the meantime, if you are interested in further learning about FODMAPs, please visit the links located below.  All I can say is that, without eating a personalized paleo diet with the elimination of dietary FODMAPs, I would not be able to get through every day life, due to the severity of the symptoms that have previously plagued my body from various overgrowths and infections.  Overall, I do still follow a low-FODMAP approach to eating, as if I do not, the "bad guys" would be very happy campers.  Of course, I do not believe I will have to eat this way for life, as I am persistently working on not only healing my gut through the autoimmune-protocol, but I also currently doing the PK Protocol, to get to the bottom of the neurotoxicity in my cells.  All in all, low-FODMAP eating is just another way that I can support my body on all levels, and though it does take away from many of the foods that otherwise would be acceptable on a ketogenic diet (or what I call, an AIP-Keto approach), there comes a point in one's illness where they will do absolutely anything to get better, and that is exactly where I have been for many years.  That being said, being aware of what foods contain FODMAPs for the everyday person can certainly serve as useful, simply because they are in many foods we eat, and knowing what we put in our bodies serves as one of the greatest means of finding and (or) maintain true health. 

Further Reading 

Monash University 

28 Days of Low-FODMAP AIP 

SIBO and FODMAPs 
The Paleo Approach 

(Pin Post For Later) 

Romans 5:13 "Now may the God of hope fill you with all joy and peace in believing, that you may abound in hope by the power of the Holy Spirit."

Ballantyne, Sarah. The Paleo Approach: Reverse Autoimmune Disease and Heal Your Body. N.p.: n.p., n.d. Print